Covered Entity Details

DSH330240N HARLEM HOSPITAL CENTER (NYCHHC) (Active) - information as of 5/27/2025 11:39:09 PM

Main Details

Name

HARLEM HOSPITAL CENTER (NYCHHC)

Subdivision Name

Child & Adolescent Psych Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH330240N

Medicare Provider Number

330240

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/31/2014

Participating Start Date

1/1/2015

Participating Approval Date

11/19/2014

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

NYC Health + Hospitals
Deborah Alyse Brown, Senior Vice President, Chief External Affairs Officer
(347) 947-0446

Primary Contact

NYC Health + Hospitals
Mark Capuano, Senior Director, Corporate Pharmacy 340B Program
(347) 835-9198

Addresses

Street Address

46 W 137th Street
New York, NY 10037

Billing Address

Harlem Hospital Center
506 Lenox Ave
New York, NY 10037

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NY	00246108	1033124961

Shipping Addresses

Shipping Address 1

Harlem Hospital Center
506 Lenox Ave
New York, NY 10037

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330240A	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)		530 LENOX AVENUE	NEW YORK	NY	Terminated
DSH330240B	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Adult Psych Clinic	512 Lenox Ave	New York	NY	Active
DSH330240C	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	ENT Clinic	46 W 137th Street	New York	NY	Active
DSH330240D	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	EYE Clinic / Ophthalmology	46 W 137th Street	New York	NY	Active
DSH330240E	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Dental/Oral Surgery Clinic	15 W 136th Street	New York	NY	Active
DSH330240F	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Orthopedics Clinic / Orthopedics	46 W 137th Street	New York	NY	Active
DSH330240G	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Medicine Clinic / Medicine	46 W 137th Street	New York	NY	Active
DSH330240H	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	HIV Clinic / HIV	15 W 136th Street	New York	NY	Active
DSH330240J	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Surgery Clinics / Surgical Clinic	46 W 137th Street	New York	NY	Active
DSH330240K	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	OB/GYN Clinic / OB/	46 W 137th Street	New York	NY	Active
DSH330240L	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Pediatrics Clinic / Pediatrics	46 W 137th Street	New York	NY	Active
DSH330240M	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Adult Behavioral Health, Continuing Day Treatment	15 W 136th Street	New York	NY	Active
DSH330240N	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Child & Adolescent Psych Clinic	46 W 137th Street	New York	NY	Active
DSH330240P	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Ambulatory Surgery	512 Lenox Ave	New York	NY	Active
DSH330240Q	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Alcohol/Chemical Dependency Clinic	512 Lenox Ave	New York	NY	Active
DSH330240R	Child	DSH	HARLEM HOSPITAL CENTER (NYCHHC)	Harlem Hospital Emergency Department (ED)	512 Lenox Ave	New York	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	Brown, Deborah Alyse Senior Vice President, Chief External Affairs Officer NYC Health + Hospitals 3479470446	11/15/2024 1:26 PM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:27:06 PM	9/3/2024 2:47:07 PM	9/3/2024 2:47 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 11:22:35 AM	8/29/2023 2:27:06 PM	8/29/2023 2:27 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 7:20:23 PM	9/2/2022 11:22:35 AM	9/2/2022 11:22 AM
Contacts	Primary Contact	Update	Group Change Request	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	Capuano, Mark Senior Director, Corporate Pharmacy 340B Program NYC Health + Hospitals 3478359198	8/23/2022 6:48 AM
Contacts	Authorizing Official	Update	AO Change Request	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	Brown, Deborah Alyse Senior Vice President, External and Regulatory Affairs NYC Health + Hospitals 3479470446	8/16/2022 7:33 AM
Contacts	Primary Contact	Update	Profile Change Request	Than, Min Sr. Director New York City Health and Hospitals 2124423854	Than, Min Assistant Vice President New York City Health and Hospitals 2124423854	8/24/2021 6:37 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 12:23:52 PM	8/19/2021 7:20:23 PM	8/19/2021 7:20 PM
Addresses	Main Address	Update	Recertification	15 W 136th Street New York, NY 10037	46 W 137th Street New York, NY 10037	9/10/2020 12:23 PM
Medicaid Billing	NPI: State	Update	Recertification		NY	9/10/2020 12:23 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 7:22:34 AM	9/10/2020 12:23:52 PM	9/10/2020 12:23 PM
Contacts	Primary Contact	Update	Change Request	Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	Than, Min Sr. Director New York City Health and Hospitals 2124423854	7/27/2020 8:16 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 2:35:47 PM	8/28/2019 7:22:34 AM	8/28/2019 7:22 AM
Addresses	Shipping Address	Insert	Recertification		Harlem Hospital Center 506 Lenox Ave New York, NY 10037	8/29/2018 2:35 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 9:38:02 AM	8/29/2018 2:35:47 PM	8/29/2018 2:35 PM
Contacts	Primary Contact	Insert	Change Request		Sestito, Danielle Senior Director, 340B Operations New York City Health + Hospitals 2124423892	11/28/2017 8:06 PM
Details	Entity Name	Update	Recertification	HARLEM HOSPITAL CENTER	HARLEM HOSPITAL CENTER (NYCHHC)	11/15/2017 10:13 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/15/2017 9:38:02 AM	11/15/2017 9:38 AM
Contacts	Authorizing Official	Update	Profile Change Request	Albertson, Paul Vice President Elmhurst Hospital 2127482256	Albertson, Paul Vice President New York City Health and Hospitals 2127482256	9/21/2017 5:59 PM
Contacts	Authorizing Official	Update	Change Request	Albertson, Paul Vice President 2127482256	Albertson, Paul Vice President Elmhurst Hospital 2127482256	9/20/2017 11:54 AM
Contacts	Authorizing Official	Insert			Albertson, Paul Vice President 2127482256	8/14/2017 11:29 AM
Contacts	Signed By	Insert			Martin, Antonio Ececutive Vice President & Chief Operating Officier 2127883479	8/14/2017 11:24 AM
Addresses	Main Address	Insert			15 W 136th Street New York, NY 10037	4/18/2017 10:36 AM
Addresses	Billing Address	Insert			Harlem Hospital Center 506 Lenox Ave New York, NY 10037	4/18/2017 10:36 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 11:01 AM
Details	Last Recertification Date	Update			8/5/2015 12:00:00 AM	8/5/2015 12:06 PM
Details	Entity Subname	Update		Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic	Child & Adolescent Psych Clinic	12/12/2014 11:21 AM
Details	Entity Subname	Update		Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic	Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic	11/19/2014 6:53 AM
Dates	Participating Approval Date	Update			11/19/2014 12:00:00 AM	11/19/2014 6:53 AM
Details	State	Update		Pending	Active	11/19/2014 6:53 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	11/19/2014 6:53 AM
Details	Entity Subname	Update		Child & Adolescent Psych Clinic	Child & Adolescent Psych Clinic / Child & Adolescent Psych Clinic	11/7/2014 11:11 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48065	DSH330240N	11/7/2014 11:10 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48065	10/31/2014 10:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/31/2014 10:32 AM
Medicaid Billing	Medicaid: Number	Insert			00246108	10/31/2014 10:32 AM
Medicaid Billing	Medicaid: State	Insert			NY	10/31/2014 10:32 AM
Medicaid Billing	NPI: Number	Insert			1033124961	10/31/2014 10:32 AM
Details	Last Recertification Date	Insert				10/31/2014 10:32 AM
Details	Grant Number	Insert				10/31/2014 10:32 AM
Details	340B ID	Insert				10/31/2014 10:32 AM
Details	Is Authorizing Official EHB Data	Insert				10/31/2014 10:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/31/2014 10:32 AM
Details	Medicare Provider Number	Insert			330240	10/31/2014 10:32 AM
Details	Entity Name	Insert			HARLEM HOSPITAL CENTER	10/31/2014 10:32 AM
Details	Program Code	Insert			DSH	10/31/2014 10:32 AM
Details	Entity Subname	Insert			Child & Adolescent Psych Clinic	10/31/2014 10:32 AM
Dates	Participating Approval Date	Insert				10/31/2014 10:32 AM
Details	State	Insert			Pending	10/31/2014 10:32 AM
Dates	Registration Date	Insert			10/31/2014 12:00:00 AM	10/31/2014 10:32 AM
Dates	Signed By Date	Insert			10/31/2014 12:00:00 AM	10/31/2014 10:32 AM
Dates	Start Date	Insert				10/31/2014 10:32 AM
Terminations	Termination Comments	Insert				10/31/2014 10:32 AM
Terminations	Termination Date	Insert				10/31/2014 10:32 AM
Terminations	Termination Effective Date	Insert				10/31/2014 10:32 AM
Terminations	Termination Reason	Insert				10/31/2014 10:32 AM